Family Check-up for Children
The Family Check-up (FCU) for Children is a strengths-based, family-centred intervention that motivates parents to use parenting practices to support child competence, mental health and risk reduction.
The intervention has two phases. The first is a brief, three-session programme that involves three one-hour sessions: interview, assessment and feedback.
The second phase is ‘Everyday Parenting’, a family-management training programme that builds parents’ skills in positive behaviour support, healthy limit-setting and relationship-building. As a health-promotion and prevention strategy, phase two of the FCU can be limited to one to three Everyday Parenting sessions. As a treatment approach, phase two can range from three to 15 Everyday Parenting sessions. The first phase may be followed by additional community referral services as indicated.
The intervention model is tailored to address the specific needs of each family and can be integrated into a variety of service settings, including schools, primary care and community clinics. Although providers implementing the intervention are typically Masters-level therapists or social workers, bachelor and paraprofessional/non-bachelor-level providers, with the appropriate consultation and supervisory support, may also implement the FCU.
A component of Family Check-up for Children seeks to improve children's outcomes by improving the quality of interparental relationships (IPR).
EIF Programme Assessment
Family Check-up for Children has evidence of a short-term positive impact on child outcomes from at least one rigorous evaluation.
What does the evidence rating mean?
Level 3 indicates evidence of efficacy. This means the programme can be described as evidence-based: it has evidence from at least one rigorously conducted RCT or QED demonstrating a statistically significant positive impact on at least one child outcome.
This programme does not receive a rating of 4 as it has not yet replicated its results in another rigorously conducted study, where at least one study indicates long-term impacts, and at least one uses measures independent of study participants.
What does the plus mean?
The plus rating indicates that this programme has evidence from at least one level 3 study, along with evidence from other studies rated 2 or better.
A rating of 2 indicates that a programme has a medium-low cost to set up and deliver, compared with other interventions reviewed by EIF. This is equivalent to an estimated unit cost of £100–£499.
According to the best available evidence for this programme's impact, it can achieve the following positive outcomes for children:
Preventing crime, violence and antisocial behaviour
This programme also has evidence of supporting positive outcomes for couples, parents or families that may be relevant to a commissioning decision. Please see About the evidence for more detail.
Family Check-up for Children
Key programme characteristics
Who is it for?
The best available evidence for this programme relates to the following age-groups:
How is it delivered?
The best available evidence for this programme relates to implementation through these delivery models:
Where is it delivered?
The best available evidence for this programme relates to its implementation in these settings:
The programme may also be delivered in these settings:
- Secondary school
- Community centre
- In-patient health setting
- Out-patient health setting
How is it targeted?
The best available evidence for this programme relates to its implementation as:
- Targeted selective
Where has it been implemented?
Canada, Netherlands, Spain, Sweden, United Kingdom, United States
This programme has been implemented in the UK.
This programme’s best evidence does not include evaluation conducted in the UK.
EIF includes this programme in the following Spotlight sets:
- Improving interparental relationships
Family Check-up for Children
About the programme
What happens during delivery?
How is it delivered?
- FCU is delivered over nine sessions of 50-60 minutes' duration each by one FCU provider (often a therapist or social worker).
What happens during the intervention?
The FCU is delivered in two phases. The first is a brief, three session intervention based on motivational interviewing. The three meetings are conducted by a professional therapist in the home. The sessions consist of a one-hour assessment session, an interview session, and a feedback session.
- The first session involves a practitioner who reviews and discusses concerns with the caregiver, focusing on family issues that are most critical to the child’s wellbeing. Specifically, the interview covers the parent’s goals and concerns within the family.
- The assessment engages family in a variety of in-home videotaped tasks of parent-child interactions, while caregivers complete questionnaires about their own, their child’s and their family’s functioning. During this session, the practitioner completes ratings of parent involvement and supervision.
- The third meeting is a feedback session where the parent consultant can summarise results of the assessment and work with the parent to assess his/her motivation and willingness to change problematic behaviour. This final session also includes an overview of the behaviours and/or practices that need additional attention. At that time, parents are offered a maximum of six follow-up sessions to continue improving their parenting practices and family management skills. Two annual follow-ups are conducted to assess progress over the long-term.
- The second phase involves the delivery of Everyday Parenting, a family management training program that builds parents’ skills in positive behaviour support, healthy limit-setting and relationship-building. As a health-promotion and prevention strategy, phase two of the FCU can be limited to one to three Everyday Parenting sessions. As a treatment approach, phase two can range from 3 to 15 Everyday Parenting sessions. The first phase may be followed by additional community referral services as indicated.
What are the implementation requirements?
Who can deliver it?
- It is delivered by one therapist or social worker who is qualified to QCF-7/8 level and has received 35 hours of programme training. With the appropriate consultation and supervisory support, a paraprofessional/non-bachelor-level practitioner also may implement the programme.
What are the training requirements?
- The practitioners have 35 hours of training. Booster training of practitioners is recommended.
How are the practitioners supervised?
- It is recommended that programme practitioners are supervised by one host-agency supervisor with QCF-7/8 level qualifications (who receives standard practitioner programme training, with an additional 28 to 45 hours of additional training support) and one programme developer supervisor also qualified to QCF.
What are the systems for maintaining fidelity?
- Training manual
- Other printed material
- Other online material
- Video or DVD training
- Face-to-face training
- Accreditation or certification process
- Booster training
- Fidelity monitoring
Is there a licensing requirement?
There is no licence required to run this programme.
How does it work? (Theory of Change)
How does it work?
- Family Check-up is based on social learning principles that assume that some parenting behaviours inadvertently encourage non-compliant behaviours in toddlerhood.
- Parents learn positive behaviour support strategies to help parents proactively structure family situations to promote children’s self-regulatory development and minimise problem behaviour.
- In the short term, parents learn positive strategies for engaging with their child.
- In the longer term, children are less likely to engage in antisocial and risky behaviour.
Family Check-up for Children
About the evidence
Family Check-up Children’s most rigorous evidence comes from an RCT which was conducted in the United States.
This study identified statistically significant positive impact on a number of child and parent outcomes.
This programme has evidence from at least one rigorously conducted RCT along with evidence from two additional comparison group studies. Consequently, the programme receives a 3+ rating overall.
|Citation:||Shaw et al (2006)|
|Sample:||120 mother-son dyads in Pittsburgh, Pennsylvania|
Reduced disruptive behaviour (boys only)
|Other outcomes:||Increased maternal involvement|
Shaw, D.S., Dishion, T.J., Supplee, L., Gardner, F. & Arnds, K. (2006). Randomized trial of a family-centered approach to the prevention of early conduct problems: 2-year effects of the Family Check-up in Early Childhood, Journal of Consulting and Clinical Psychology, 74, 1-9.
|Citation:||Dishion et al (2008), Shaw et al (2009), Lunkenheimer et al (2008), Dishion et al (2014)|
|Sample:||731 mother-child dyads|
Reduced externalising behaviours
Reduced problem behaviour
Reduced internalising behaviours
Reduced defiant behaviour
|Other outcomes:||Improved parent-child interaction
Reduced maternal depression
Improved parent-child interaction
Dishion, T.J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The Family Check-up with high-risk indigent families: Preventing problem behaviour by increasing parents’ positive behaviour support in early childhood. Child Development, 7, 1395-1414.
Shaw, D.S., Connell, A., Dishion, T.J., Wilson, M.N. & Gardner, F. (2009). Improvements in maternal depression as a mediator of intervention effects on early childhood problem behaviour. Developmental Psychopathology, 21, 417-439.
Lukenheimer, E.S. (2008). Collateral benefits for the family check-up on early childhood school readiness: Indirect effects of parents’ positive behaviour support. Developmental Psychopathology, 44, 1737-1752.
Dishion, T.J, Brennan, L.M., Shaw, D.S., McEachern, A.D., Wilson, MN., & Booil, J. (2014). Prevention of problem behaviour through annual family check-up in early childhood: Intervention effects from home to early elementary school. Journal of Abnormal Child Psychology, 42, 343-354.
|Citation:||Garbacz et al., 2018|
|Sample:||365 families, with children between 4 and 6 years old with a mean age of 5.45 years, where families have children enrolled in schools receiving federal funds for having a higher-than-average percentage of low-income students.|
|Timing:||Interim measurement (1 year before end of intervention); Post-test|
|Child outcomes:||Decreased emotional and behaviour problems|
|Other outcomes:||None measured|
Garbacz, S. A., McIntyre, L. L., Stormshak, E. A., & Kosty, D. B. (2020). The Efficacy of the Family Check-Up on Children’s Emotional and Behavior Problems in Early Elementary School. Journal of Emotional and Behavioral Disorders, 28(2), 67-79.
Study design and sample
The third study is an RCT.
This study involved random assignment of children to an FCU treatment group and a business-as-usual group.
The study was conducted in the USA, with a sample of children between the age of 4 and 6. 65% of children were eligible for free or reduced-price school lunches.
Emotional and behavioural problems was measured using the Strengths and Needs Survey (teacher report)
This study identified statistically significant positive impact on a number of child outcomes:
- This includes reduced emotional and behavioural problems.
The conclusions that can be drawn from this study are limited by methodological issues pertaining to non-blind data collection and a lack of clarity in terms of attrition, hence why a higher rating is not achieved.
The following studies were identified for this programme but did not count towards the programme's overall evidence rating. A programme receives the same rating as its most robust study or studies.
Garbacz, S. A., Stormshak, E. A., McIntyre, L. L., & Kosty, D. (2019). Examining family-school engagement in a randomized controlled trial of the family check-up. School Psychology, 34(4), 433–443.
Stormshak, E. A., McIntyre, L. L., Garbacz, S. A., & Kosty, D. B. (2020). Family-centered prevention to enhance parenting skills during the transition to elementary school: A randomized trial. Journal of family psychology, 34(1), 122–127. https://doi.org/10.1037/fam0000570